Every Friday, Jennifer Evans compiles this selection of recently released health policy studies and briefs.
American Journal of Public Health: Public Health Insurance In Oregon: Underenrollment Of Eligible Children and Parental Confusion About Children's Enrollment Status – Based on analyses of the Food Stamp Program and Oregon Health Plan (the state's combined Medicaid-CHIP program) databases and a statewide survey of families, the authors report that more than 20 percent of parents whose children were not enrolled reported that they were, while more than 11 percent who had children in the OHP program reported their kids were not covered: "[C]hildren who appeared to be eligible for public insurance but were definitely uninsured were more likely to be older than 4 years, to live in a household earning more than $1500 per month, to have an uninsured parent, to have a parent working outside the home, and to have no usual source of care." (Devoe, Ray and Graham, 3/11).
Institute of Medicine: Finding What Works In Health Care: Standards for Systematic Reviews – Systematic reviews are scientific examinations of comparative effectiveness research (CER) to determine what treatments and drugs work and they "should be at the center of programs developing a coordinated approach to comparative effectiveness research (CER), both for setting priorities among individual CER studies and for appropriately focusing studies during their design ... ," write the authors of this report that recommends 21 standards to ensure that such reviews are objective, transparent and scientifically valid. "The IOM's standards address the entire systematic review process, from locating, screening, and selecting studies for the review, to synthesizing the findings (including meta-analysis) and assessing the overall quality of the body of evidence, to producing the final review report," according to a summary (3/23).
Urban Institute: How Will The Affordable Care Act Affect Jobs? – "The ACA is unlikely to have major aggregate effects on the U.S. economy and on employment primarily because the changes in spending and taxes are very small relative to the size of the economy. Moreover, most of the effects offset each other," according to this brief. The authors add: "Whether slightly positive or slightly negative, the ACA should not have a significant impact on overall employment" (Holahan and Garrett, March 2011).
Kaiser Family Foundation: A Profile Of Health Insurance Exchange Enrollees – "This March 2011 report describes those 24 million Americans expected to purchase private health insurance through the new Health Insurance Exchanges. Among the key findings from the report is that those purchasing coverage are likely to be relatively older, less educated, and more racially diverse and report to have poorer health, but have fewer diagnosed conditions than those who currently have private insurance," according to the authors of this report. They add: "We estimate that sixty-five percent of individuals expected to purchase health insurance through the Exchange [will] transition from being uninsured" (Trish, Damico, Claxton, Levitt and Garfield, 3/21).
Robert Wood Johnson Foundation/Center for Studying Health System Change: State Variation In Primary Care Physician Supply: Implications For Health Reform Medicaid Expansions – The Medicaid expansion scheduled to begin in 2014 under the new health law "is likely to greatly outpace growth in the number of primary care physicians (PCPs) willing to treat these new patients." Currently, "[s]tates with the highest levels of PCP supply—relative to the population—are concentrated almost entirely in the Mid-Atlantic and Northeast, while states with the lowest PCP supply are concentrated largely in the South and Mountain West." In addition, the low-PCP states are most likely to gain the highest percentage of Medicaid enrollees. But those states, which historically have trouble attracting physicians to the Medicaid program, already offer higher reimbursement rates so "the temporary increase in Medicaid reimbursement rates for primary care will have less impact on increasing the supply of Medicaid PCPs in these states compared to high-PCP states," the author writes (Cunningham, 3/17).
Related KHN story: Doctor Shortages Under Health Law May Depend On Geography (Marcy, 3/17)
Urban Institute: Who Will Be Uninsured After Health Insurance Reform? – "Health care reform will substantially change both the number and the composition of the uninsured," write the authors of this brief that estimates changes to the number of uninsured if the health law were fully implemented in 2011. Based on their simulation, the authors predict: "Of the nonelderly adults uninsured under national health reform, 37 percent would be eligible for Medicaid but not enrolled and 25 percent would be undocumented immigrants. Sixteen percent would be exempt from the individual mandate because they had no affordable insurance option. The authors find significant state and regional variation in the characteristics of the uninsured" (Buettgens and Hall, March 2011).
Kaiser Commission on Medicaid and the Uninsured: Determining Income For Adults Applying For Medicaid And Exchange Coverage Subsidies: How Income Measured With A Prior Tax Return Compares To Current Income At Enrollment – While the new health law "standardizes the definition of income used to determine eligibility for Medicaid and premium tax credits for Exchange coverage to [Modified Adjusted Gross Income], there remain important distinctions related to the timing of income used to determine eligibility," according to this brief. "Overall, these findings suggest that use of prior tax income could serve as an accurate measure of income for most adults when they apply for coverage. However, a considerable share of adults have differences between their current and prior tax income that would affect which income eligibility category they would fall into at the time of application. As a result … some adults ... may have difficulty affording coverage and/or paying required cost sharing to access needed care" (3/18).